High-Dose Isotretinoin Treatment and the Rate of Retrial, Relapse, and Adverse Effects in Patients With Acne Vulgaris

Abstract

The dosing regimen used in the present study is considerably higher than that used in previous studies of isotretinoin. At 1 year after completion of isotretinoin treatment, we found that patients receiving 220 mg/kg or more had a significantly decreased risk of relapse. Rash was the only adverse effect that was significantly more common in the high-dose group during treatment. This study suggests that significantly higher doses of isotretinoin are effective for treating acne and decreasing relapse rates without increasing adverse effects.

Evaluation of Evidence for Acne Remission With Oral Isotretinoin Cumulative Dosing of 120-150 mg/kg

“…23 Five from the alternative dosing phase used temporal endpoints. 24,25,27,28,31 During this phase, other definitions varied from clinical clearance of all lesions, 11,26 clearance of almost all lesions, 19,32 or cumulative dosing. 20,29,32 Dosing Regimens All 8 studies during the initial and extended duration phases used only continuous daily dosing regimens.…”

“…18 Five observational studies in the extended duration and alternative dosing phases defined relapse as acne severe enough to require oral therapy. 4,11,17,21,23 Seven studies used an increase in acne grading scores as the definition for relapse, including 2 moderate grade RCTs from the alternative phase. [24][25][26][27]29,31,32 One study used predefined lesion counts for comedones, papules/pustules and nodulocystic lesions as a threshold for determining relapse.…”

Isotretinoin: efficacy and safety (literature review)

“…[28] предложили назначать препарат в низких суточных дозах 0,1-0,3 мг/кг. Другим альтернатив-ным вариантом использования средства является его применение в дозе более 1,0 мг/кг/сут для дости-жения кумулятивной дозы не менее 150 мг/кг [29].…”

“…По мнению экспертов [27][28][29][30], этих пациентов следует разделить на три группы с учетом повыше-ния возможного риска побочных эффектов препа-рата. Пациенты 1-й группы включают больных, страдающих сахарным диабетом, болезнью Крона, язвенным колитом, эпилепсией.…”

“…Blasiak и соавт. [29] наблюдали 180 пациентов с акне, устойчивым к другим видам терапии. Боль-ные получали изотретиноин в кумулятивной дозе менее 220 мг/кг и более 220 мг/кг.…”